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Assisted dying dominates debate

For the third year in a row, end-of-life care and the issue of assisted dying received top billing at the CMA’s annual meeting.

During a three-hour, no-break discussion held Aug. 24 – part of the 148th annual meeting in Halifax – the 275 delegates tackled three major questions:

  • What are the processes that should be followed after a patient requests medical aid in dying?
  • Who is eligible for medical aid in dying?
  • Since some physicians will decline to participate in assisted dying, what mechanisms can be employed to ensure that patients still have access to it?

There was no shortage of debate; dozens of delegates lined up at the microphones. “Today we heard physician delegates dig into the critical topic of the physician’s responsibility in assisted dying in Canada,” said CMA President Chris Simpson when the session ended. “For physicians, this is an issue that lies at the very heart of our commitment to provide high-quality care for our patients.”

The day’s discussion was launched by Dr. Jeff Blackmer, who observed that the CMA has never spoken in favour of or against assisted dying. “We have members on both sides of the issue,” said Blackmer, who is the association’s vice-president of medical professionalism. He referred to a recent poll that indicated 29% of CMA members said they would help a patient who requested aid in dying.

Blackmer noted the CMA has been playing a key behind-the-scenes role that included a heavily cited submission to the Supreme Court of Canada in its Carter case deliberations and preparation of a framework for a Canadian approach to medical aid in dying. Delegates also received a thorough briefing on Quebec’s law on medically assisted death, which takes effect Dec. 10, 2015, from lawyer Jean-Pierre Ménard.

The debate that followed made clear several important points.

First, medical students and residents attending the Halifax meeting spoke strongly against allowing physicians who refused to provide medical aid in dying to also refuse to refer a patient for the service. “Our role is not to tell patients what to do,” said one medical student. “It is to tell them the facts.”

A medical resident based in northern Manitoba added: “We need to keep in mind that the patient comes first.”

However, another physician – a representative of the Christian Medical and Dental Society – argued against making the referral of patients seeking aid in dying mandatory. She said such referral is “akin to participation” in assisted death. A physician who was one of many to speak at the session an observer at the meeting said she had flown to Halifax from Vancouver, at her own expense, to make her views known. “I do not want to be forced to participate in mandatory referral.”

“What we’ve seen today is true, thoughtful leadership,” Simpson told delegates as the session ended. “Today we had fruitful dialogue on a difficult topic — in Calgary two years ago, we couldn’t even agree on what definitions to use.”

Simpson added that the Aug. 24 discussions will be used when the CMA drafts its final working paper on end-of-life care. “Today’s discussion was not meant to reopen discussion of the morality or rightness of the Supreme Court decision … The results of today’s discussion will allow the CMA to go forward with regulators, governments and others to try and find a solution that will not force physicians to participate in assisted dying against their moral or religious beliefs, while … making sure access is available for patients who qualify.”

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